National Liver Review Board (NLRB) guidance was updated effective Feb. 1, 2022, regarding liver transplant candidates who may qualify for an exception score due to hepatocellular carcinoma (HCC) or encephalopathy. A policy clarification also took effect Feb. 1. Both components are detailed in this policy notice.
The updated guidance and policy do the following:
- add information regarding candidates with hepatocellular carcinoma (HCC) who were treated with immunotherapy, and clarify the waiting period for candidates with a history of resected HCC
- include new references and clarify language regarding candidates with encephalopathy
- clarify requirements for submitting a chest CT for candidates with an HCC exception
Liver transplant program staff should familiarize themselves with the updates. They did not affect any candidate’s exception score that was current at the time of implementation. They may, however, affect qualifications of candidates who may benefit from an exception, or the information needed to submit with future exception requests.
In approving these actions, the OPTN Board of Directors also approved updates to alcohol-associated diagnoses on the Transplant Candidate Registration (TCR) and Transplant Recipient Registration (TRR) forms. Although these updates are addressed in the same policy notice, they were not implemented Feb. 1. They are scheduled to take effect in June 2022.
The NLRB updates stem from ongoing, systematic review of NLRB-related policy and guidance by the OPTN Liver and Intestinal Organ Transplantation Committee.